What You Don’t Know About PCOS
by Krista Russ
August 8, 2023
Polycystic Ovarian Syndrome (PCOS) is a poorly understood female disorder, often characterized by missed or absent periods, infertility, sugar cravings, and great difficulty losing weight. It is also the most common reproductive disorder and leading cause of infertility in females, but does that mean we understand it well [1]? Unfortunately, no. PCOS is widely misunderstood. Most doctors don’t even understand it well.
Often, women with PCOS are told to just eat less and exercise, which undermines the complexity of the illness and is not fair to patients because it assumes they are to blame, or that lifestyle changes will make PCOS magically disappear. The reality is it doesn’t. PCOS is a complex disease–not a choice.
This article aims to clear things up by showing what PCOS is really about based on the most up-to-date, compelling evidence.
To find a doctor near you, simply search the Bio-Identical Hormone Therapy (BHRT) Provider Directory.
PCOS Not an Ovarian Problem
The term “Polycystic Ovarian Syndrome” is a poor choice of terminology because the definition implies the problem lies in the ovaries. Many women with PCOS don’t even have cystic ovaries. While the ovaries are affected by PCOS, the root cause of PCOS goes far beyond the ovary. The ovaries and menstrual cycle is actually controlled by the brain, which releases hormones like Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which are often disrupted in PCOS.
For example, PCOS is characterized by chronically elevated LH levels–a problem that lies in the brain’s pituitary gland–not the ovary. Also, insulin, yet another hormone produced outside the ovary, is disrupted in PCOS, as most women with PCOS have some degree of insulin resistance. These are both hormonal problems that have nothing to do with the ovaries. So while ovarian dysfunction is a result of PCOS, it is not the cause of it. PCOS is a metabolic disorder–affecting the whole body–not just a reproductive one.
PCOS is (partly) autoimmune
There is now strong evidence linking an autoimmune component to PCOS, meaning the body might be attacking its own healthy tissues by mistake. We know this due to the presence of inflammation and auto-antiobides commonly seen in PCOS, such as anti-ovarian, anti-spermatic, and anti-islet cell antibodies [1].
PCOS is Inflammatory
A great deal of research shows that women with PCOS often have higher levels of low grade inflammation–a type of chronic inflammation [2]. While acute inflammation is a normal, healthy part of the immune response that happens in response to tissue injury, chronic inflammation can smolder for years, leaving a great deal of damage in its wake. For instance, chronic inflammation of the uterine lining can interfere with implantation, preventing successful pregnancy.
PCOS is Genetic
Though lifestyle can influence disease severity, PCOS is likely genetic in origin. We know this because PCOS tends to run in families. For example, if your mother has PCOS, you are up to 70 percent more likely to have it yourself as her daughter [3] . Also, many women with PCOS are overweight or obese (but not all), but most overweight women do not have PCOS. If PCOS were caused by weight gain alone, more overweight women would be affected–especially when compared to other ailments that frequently co-occur with obesity (high blood pressure, type two diabetes, etc.). Furthermore, it doesn’t explain why lean, fit women can and often do have PCOS.
Genes that play a role in fat cell function, energy metabolism, and glucose regulation may have alterations called polymorphisms that could be responsible for some of the traits seen in PCOS, such as those found on the PPAR-y gene [4].
In fact, there is evidence that PCOS is likely present in infancy–but doesn’t “activate” until puberty and menarche, when the ovaries kick on and physical effects become noticeable [5].
The Bottom Line
If you have PCOS, it’s not your fault. There is still much to be learned about PCOS due to an unfortunate lack of funding for research. What we do know is that it is a biological disorder–not a character flaw caused by sloth or gluttony–and that’s great news for all those PCOS warriors out there. By better understanding this disorder, you can treat it more effectively.
To discover the most up-to-date, evidence based treatments for PCOS, check out our next blog that builds on this one: The Top 5 Myths About PCOS.